Pathology: Oesophagus & Mouth

Question 1

What is the GOJ line?

Answer 1

Gastro-oesophageal junction

Question 2

What does the Z line represent?

Answer 2

Squamo-columnar junction

Question 3

What are causes of acute oesophagitis and how common is it?

Answer 3

• corrosive due to chemical ingestion
• infective in immunocompromised (e.g.candidiasis, herpes, CMV)
• rare

Question 4

What is CMV?

Answer 4

Cytomegalovirus (in herpes family)

Question 5

What are causes of chronic oesophagitis and how common is it?

Answer 5

• reflux oesophagitis
• rare is Crohn’s disease
• common

Question 6

What is reflux oesophagitis?

Answer 6

Inflammation of the oesophagus due to refluxed low pH gastric content

Question 7

What can cause oesophagitis?

Answer 7

• defective sphincter function +/- hiatus hernia
• raised intra-abdominal pressure e.g. pregnancy
• abnormal oesophageal motility

Question 8

What is a hiatus hernia?

Answer 8

Hiatus (opening where oesophagus goes through diaphragm) is larger than normal and part of stomach slips through

Question 9

How does reflux oesophagitis appear macroscopically?

Answer 9

• red, inflammed oesophagus

- black/purpley oesophagus

Question 10

How does reflux oesophagitis appear microscopically?

Answer 10

• basal zone epithelial expansion due to increased cell division due to increased cell desquamation (shedding)
• intraepithelial neutrophils, lymphocytes and eosinophils
• elongation of connective tissue papillae

Question 11

What is Barrett’s Oesophagus?

Answer 11

Replacement of stratified squamous epithelium by columnar epithelium

Question 12

What are complications of reflux oesophagitis?

Answer 12

• stricture (narrowing)
• ulceration (bleeding)
• Barrett’s Oesophagus

Question 13

What causes metaplasia of cells in Barrett’s oesophagus?

Answer 13

Persistent reflux of acid/bile

Question 14

What may the columnar cells come from?

Answer 14

• Expansion of columnar epithelium from gastric glands or from submucosal glands
• From oesophageal stem cells

Question 15

Why do columnar cells replace squamous in Barrett’s Oesophagus?

Answer 15

They regenerate faster and as a protective response

Question 16

What is a macroscopic sign of Barrett’s Oesophagus?

Answer 16

Red velvety mucosa in lower oesophagus

Question 17

What is a microscopic sign of Barrett’s Oesophagus?

Answer 17

Columnar lined mucosa with intestinal metaplasia

Question 18

What are two results of Barrett’s Oesophagus?

Answer 18

• unstable mucosa (continuing damage)

- increased risk of developing dysplasia and carcinoma of the oesophagus (intestinal metaplasia)

Question 19

What is another name for allergic oesophagitis?

Answer 19

Eosinophillic oesophagitis

Question 20

What factors is (age group, sex, medical history, family history) is allergic oesophagitis usually associated with?

Answer 20

• young
• males more than females
• history of asthma
• family history of allergy

Question 21

What are two clinical findings of allergic oesophagitis?

Answer 21

• raised eosinophils in blood

- pH probe negative for reflux

Question 22

How does allergic oesophagitis present in endoscopy (macroscopically)?

Answer 22

Corrugated (feline) or spotty oesophagus

Question 23

How does allergic oesophagitis present microscopically?

Answer 23

Large number of intraepithelial eosinophils

Question 24

What are possible treatments for allergic oesophagitis?

Answer 24

• steroids
• monteleukast
• chromoglycate

Question 25

What are the features of benign oesophageal tumours?

Answer 25

- squamous papilloma - rare - papillary - HPV related - asymptomatic

Question 26

What are some very rare causes of benign oesophageal tumours?

Answer 26

- leiomyomas - lipomas - fibrovascular polyps - granular cell tumours

Question 27

From what cells do Leiomyomas grow?

Answer 27

Smooth muscle cells

Question 28

From what cells do lipomas grow?

Answer 28

Fat cells

Question 29

From what cells are granular cell tumours thought to grow?

Answer 29

Schwann cells

Question 30

What are the two types of malignant oesophageal tumours?

Answer 30

- squamous cell carcinoma | - adenocarcinoma

Question 31

What 6 potential causes of squamous cell carcinoma?

Answer 31

1. smoking/alcohol 2. Vitamin A, Zinc deficiency 3. HPV 4. Tannic acid/strong tea 5. Oesophagitis 6. Genetic

Question 32

What malignant oesophageal tumour is associated with Barrett's Oesophagus?

Answer 32

Adenocarcinoma

Question 33

What can patient with squamous cell carcinoma in the oesophagus present with?

Answer 33

Dysphagia

Question 34

What are the 3 steps in the pathogenesis of squamous cell carcinoma?

Answer 34

Normal -> GORD -> severe dysplasia

Question 35

What factors (sex, weight, ethnicity, where in oesophagus) are related to higher risk of adenocarcinoma?

Answer 35

- males - obese - caucasian - lower 1/3

Question 36

What are the 6 steps in the pathogenesis of adenocarcinoma?

Answer 36

genetic factors, reflux disease -> chronic reflux oesophagitis -> Barrett's Oesophagus (intestinal metaplasia) -> Low-grade dysplasia -> High-grade dysplasia -> adenocarcinoma

Question 37

What are the mechanisms of metastases of oesophageal carcinomas and examples of where?

Answer 37

- direct invasion e.g. local invasion - lymphatic permeation e.g. nodal metastases - vascular invasion e.g. to liver

Question 38

How might oesophageal carcinoma present clinically?

Answer 38

- dysphagia | - general malignancy symptoms e.g. weight loss, fatigue, anaemia (due to metastases)

Question 39

What is a Mallory Weiss tear?

Answer 39

A tear in the mucous membrane often at the gastro-oesophageal junction often caused by excessive coughing/vomiting. Can cause severe GI bleeding.

Question 40

What are oesophageal varices?

Answer 40

Enlarged blood vessels in oesophagus often due to obstructed blood flow through portal vein

Question 41

What are most oral carcinomas?

Answer 41

Squamous cell carcinomas

Question 42

How can oral carcinomas present?

Answer 42

red, white, speckled, lump, ulcer

Question 43

What are the high risk sites of developing oral carcinomas?

Answer 43

- lateral borders and ventral tongue - soft palate - retromolar pad - tonsillar pillar - floor of mouth

Question 44

What are some potential causes of oral carcinoma?

Answer 44

- smoking - alcohol - betel quid (tobacco and betel nut chew) - patient with primary oral SCC at risk of developing secondary oral SCC - post transplant - potentially HPV - potentially chronic infections

Question 45

What are two variants of oral carcinoma histopathology?

Answer 45

verrucous(warty lesions) and acantholytic (loss of intracellular connections e.g. desmosomes)

Question 46

How are oral carcinomas graded?

Answer 46

- TNM system | - factors e.g. degree of differentiation, depth and pattern of invasion, lymphovascular invasion etc.

Question 47

What does TNM stand for?

Answer 47

- T -> greatest diameter of tumour, structures invaded - N -> lymph node status - M -> metastasis

Question 48

What is survival rates of oral carcinoma?

Answer 48

5yr 40% -50%

Question 49

What is treatment for oral carcinoma?

Answer 49

surgery +/- adjuvant therapy